Brief Solution Focused Therapy BSFT Steve Thomas Senior
Brief, Solution Focused Therapy (BSFT) Steve Thomas- Senior Counsellor ABUHB Adult Weight Management Service
“It is unhelpful for a therapist to be too strongly tied to one specific approach – People come to sort out their problems, not to receive our favourite therapy” (William Davies) If you only have a hammer in your toolbox, you’ll treat everything you come across like a nail! (Steve Thomas)
What is Brief, Solution focused therapy? BSFT comes from two roots: Brief, strategic therapy Solution Focused therapy developed by Steve de Shazer and Insoo Kim Berg
Brief Therapy Concentrates on: Strategy: both of client and therapist and Resources (solutions) the client already has available May focus on the family and the social system in which the client lives and look for solutions there Other times may concentrate on the individual Sometimes yields striking, rapid, successes
Solution-focused therapy �Looks at solutions more than problems. May therefore seek to answer the questions: �How can she become happier? Rather than: What makes her depressed? �How can he be more relaxed? Rather than: Why does he become anxious? �How can she manage her weight more effectively? Rather than “Why does she eat so much ? ” �Answers may come either from therapist or from other areas of the client’s life
BSFT Examines the strategies that can be used to produce an effective therapy that doesn’t take long. Examines the strategies a person uses to tackle their problems and having them use more adaptive strategies and less maladaptive ones. Examines the solutions that the person uses in other areas of their life and generalises them Focuses on new solutions, rather than problems.
Comparisons between problem/pathology and solution/strengths approaches: • • PF - Focus on understanding fixed problem patterns in client’s lives SF - Focuses on understanding how change occurs in clients lives and what possibilities are open to them • • PF - Elicit detailed descriptions of problems and unwanted pasts SF - Elicits detailed descriptions of goals and preferred futures • • PF - Person is categorised by the problems and diagnoses they have SF - Person is seen as more than the problem, with unique talents and strengths and a personal story to be told • • PF - Focus on identifying ‘what’s wrong’, ‘what’s not working’ and on deficits in individuals SF - Focuses on identifying ‘what’s right’ and ‘what’s working’ , on strengths, skills and resources in individuals
• • PF - Clients invariably resist change or therapy SF - Resistance’ is created when therapeutic goals /methods or alliance do not fit with the client. The onus is on therapist to adapt therapy to the client’s goals and create a constructive alliance • • PF - Therapy has to be long term to create enduring change SF – Therapy can be brief in creating pivotal change in client’s lives • • PF - Trauma invariably damages clients and predicts later pathology SF- Trauma is not predictive of pathology (as it may weaken on strengthen the person)The therapist is interested in how the client has coped with the trauma. • PF - Centrepiece of therapy is the treatment plan devised by therapist who is the ‘expert’ SF – Centrepiece of therapy is the clients’ goals, coupled with their strengths, resources and expertise in their own lives, to move towards them • Adapted from Saleeby (1996) and Sharry (2001)
Principles of BSFT Focusing on change and possibilities Creating Goals and preferred futures Building on strengths, skills and resources Looking for ‘what’s right’ and ‘what’s working’ Being respectfully curious Creating co-operation and collaboration
Strategies of BSFT Asking questions Scaling questions Reframing Finding solutions the client already has Exploring exceptions Setting ‘homework’
Asking Questions? ? ? As a general rule; asking questions is a more effective way of influencing people then ‘instruction’ is
A Solution focussed question has 2 key qualities: 1. It focuses on solutions, not problems 2. So long as you can answer it, the answer will probably eliminate the problem
Exercise: Turning problem focused questions to solution focussed: How can we stop him being aggressive? How can we help him stay calm? What do we do when she threatens to harm herself? How can we help her: manage her thoughts of self harm/express her feelings? How can we stop her binge-eating? How can we help her eat healthily?
Creating a preferred future The Miracle Question (de Shazer) Suppose that one night there is a miracle and while you are sleeping the problem that brought you here today is solved. How would you know? What would you notice different the next morning that will tell you there has been a miracle? What will others notice?
Another BSFT question “Suppose, 6 months from now, you are looking back and you say to yourself: ‘If only I done ‘this-or-that’ 6 months ago, my problem would have been sorted out by now’ : What would ‘this-or-that’ be? ” How could you use the person’s response?
Scaling Questions Scaling questions can be some of the biggest tools to have in our toolbox. They give us a measure of what is happening and may transform the way the person views their situation. They automatically suggest that “things could be worse” (which is something we cannot say directly) They give hope, by implying the likelihood of movement.
Examples of Scaling Questions: If 10 is you at your best and 1 is at your most depressed, where are you now? If 10 is blind panic and 1 is completely calm, where are you when in a crowded shop? If 0 is not at all distressed and 10 is as distressed as anyone could possibly be, where are you right now? If 0 is completely starving and 10 is completely full, where are you usually when you eat your evening meal?
Scaling questions Think of an example of a scaling question you might ask?
Looking for exceptions
Looking for exceptions “When and why does the problem not occur in situations where you would expect it to? ” “What are you doing differently on those occasions? ” If clients could answer that, then maybe they would have the answer to their problem?
Exploring exceptions and solutions Exceptions may automatically provide the answers to the problem i. e “When can you guarantee not being depressed? ” “When do you not comfort eat? ” “When can you guarantee not having a panic attack? ” “When do you not argue with your partner? ”
“When do you not comfort eat? ” Answers might include: When I’ve come back from a long walk When I’m with my best friend When I can control my thoughts On a Friday When I’m busy/distracted How might you use this information?
Exceptions and Solutions “How come you don’t comfort eat on Friday? The answer to such a question can give us the template for success. If we can find out what happens on Friday – the person can copy it – or something similar- on other days. .
Template for success A template is ‘a perfect example’ that can be copied again The ‘template’ is obtained by: 1. Noticing an instance of success and 2. Analysing what led to that success Thereafter, all you need to do is repeat what led to the success in the first place
Exercise: “Can you think of a time where you identified something that had gone right, worked out why it had gone right and deliberately copied that strategy again and again? ”
Reframing Viewing the problem from a different perspective:
Reframing A lecturer, having forgotten his lecture notes and slides may panic and see only the need to hurriedly reconstruct those he can remember How else might he see it? Can you think of an example of a reframe you used with a patient?
It all depends on how you look at it!
Strategies that don’t work! People will sometimes adopt strategies to resolve their problems that actually make their problems worse: When anxious people find that avoiding anxiety-provoking situations does not rid them of anxiety, they may avoid even more situations When people comfort eat and don’t feel any better, they may indulge in more comfort food When angry people find their behaviour does not yield the respect they crave from others, they may become angry more often
The person’s ‘solution’ may be fuelling their problem When anxious people see themselves avoiding situations, they may infer they are incapable of facing any of life’s challenges. When people’s comfort eating causes further weight gain, they feel guilty and tell themselves that they will never be able to stop, so continue to eat more. When people who crave respect become angry at not getting it, they may further alienate the very people they want to respect them
When this happens, we need to: Identify the problem, the strategy is being used for Help the person identify a better strategy Enable the person to use this better strategy
‘Homework’ Can be observational or experiential i. e “Between now and the next time we meet, I want you to observe – so you can tell me next time - what happens in your life that you want to continue to have happen” “Between now and next session –you’re going to try to use relaxation/mindfulness to self soothe instead of comfort eating”
As a society, we love to focus on the negatives! “For every academic paper that is published on happiness, there are over 100 on depression” (Zimbardo)
Group exercise!!!
Speaker: Identify something that is going well in your life at the moment (activity, relationship, job, something you’re proud of etc) and talk about it! Listener: Listen carefully, encourage speaker to elaborate. Ask questions like: What went well? What pleased you the most? How did this good thing happen/how did you help bring it about? What particular qualities do you have that helped this to happen? What do these strengths/qualities say about you as a person?
What does the research show? As of Nov 2012: � 120 relevant studies � 2 Meta-analyses � 23 RCT (12 showing benefit over existing methods) �Of 45 comparison studies, 36 favour BSFT �When compared to CBT, BSFT took significantly less sessions �Effectiveness data available from more than 5000 cases with success rates exceeding 60% (requiring an average of 3 -5 sessions of therapy) �So far, no study has identified a particular problem or client group for whom the approach is ineffective (with exception of obvious limits imposed by biological conditions i. e Dementia)
Further reading suggestions: A Brief Guide to Brief Therapy, by Brian Cade & William Hudson O’Hanlon Solution-Focussed Therapy, by Bill O’Connell Children’s Solution Work – Insoo Kim Berg, &Therese Steiner Handbook of Solution Focussed therapy – Bill O’Connell & Stephen Palmer A Guide to possibility land: 51 Methods for doing Brief Respectful therapy – Bill O’Hanlon & Sandy Beadle
Thanks for listening Any questions?
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